Colorectal Cancer in African Americans: An Update

Abstract

This review is an update to the American College of Gastroenterology (ACG) Committee on Minority Affairs and Cultural Diversity's paper on colorectal cancer (CRC) in African Americans published in 2005. Over the past 10 years, the incidence and mortality rates of CRC in the United States has steadily declined. However, reductions have been strikingly much slower among African Americans who continue to have the highest rate of mortality and lowest survival when compared with all other racial groups. The reasons for the health disparities are multifactorial and encompass physician and patient barriers. Patient factors that contribute to disparities include poor knowledge of benefits of CRC screening, limited access to health care, insurance status along with fear and anxiety. Physician factors include lack of knowledge of screening guidelines along with disparate recommendations for screening. Earlier screening has been recommended as an effective strategy to decrease observed disparities; currently the ACG and American Society of Gastrointestinal Endoscopists recommend CRC screening in African Americans to begin at age 45. Despite the decline in CRC deaths in all racial and ethnic groups, there still exists a significant burden of CRC in African Americans, thus other strategies including educational outreach for health care providers and patients and the utilization of patient navigation systems emphasizing the importance of screening are necessary. These strategies have been piloted in both local communities and Statewide resulting in notable significant decreases in observed disparities.

Colorectal Cancer Demographics and Survival in a London Cancer Network

“…This may well be a trend that will be seen in the UK. Improved cancer survival rates are seen in the under 40 age group, and are enhanced further if they are physically fit [1,9,11]. This corresponded with the findings in this study, which demonstrated the median and overall survival rate for the under 40 age group to be 94.7 months and 67.4% respectively.…”

“…Like all cancers, colorectal cancer remains a multi-factorial disease with multiple risk factors, such as lifestyle choices (particularly exercise, diet and weight) and access to healthcare, each playing a role [1,9,11,17]. The results outlined above suggest that age, gender, ethnicity and tumour site may be implicated in determining prognosis, specifically with regard to survival rates.…”

“…This could be a reflection of socioeconomic differences amongst patients which in turn influences outcomes and survival rates when treating all types of cancers [13,14]. Other similar studies have reported that black patients have far worse outcomes [11] often due to higher obesity rates and poor diet. Although obesity was not considered here, these results would infer otherwise.…”

“…There is increasing thought being given to the impact that ethnicity, age and gender influence the way in which patients initially present with suspected cancer and the degree to which they consent to diagnostic tests and treatments [7,8,9,10]. It has also been suggested that racial factors play a role in colorectal cancer survival rates, although this remains disputed [8,11].…”

Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer

“…Relative to other races, African Americans have lower screening rates for CRC, higher incidence rates, earlier mean age at onset, worse survival and late-stage presentation, and a higher proportion of cancers before age 50 (140)(141)(142)(143). Th ese various eff ects result from both socioeconomic and biologic factors ( 144 ).…”